In 2012, video of electric shock conditioning used inside the Judge Rotenberg Educational Center was released to the public for the first time. It showed 18-year-old Andre McCollins being restrained face down, shouting for help from the people around him. His calls go unanswered, and he is given repeated shocks which cause him to scream in pain.

The footage appears to show McCollins being tortured. The Judge Rotenberg Center (JRC) is not a rogue interrogation facility in a failed state, however, but a facility for children and adults with learning disabilities in Massachusetts.

Last week the facility won another legal challenge, which will allow it to continue to use shock treatment on its students.

A lawsuit had been brought by the Massachusetts governor’s office, which first sued to stop the practice in 2013. But Judge Katherine Fields of the Bristol county probate and family court ruled that the state had failed to demonstrate that the procedure “does not conform to the accepted standard of care for treating individuals with intellectual and developmental disabilities”.

The school remains the only facility in the US that is allowed to use electric shocks on children for behavioral purposes.

The center, founded in 1971 as the Behavior Research Institute, serves “emotionally disturbed” individuals and those with learning disabilities. Since its inception it has used an unusual form of treatment – the graduated electronic decelerator, or GED, an electric shock device, developed by the center’s founder, Matthew Israel.

The device is not used in what we might call “electroshock therapy” – where small shocks are passed through the brain under anesthesia. Rather, the GED is used as a variation of “aversive conditioning”, in which negative stimulation is applied to a patient when he or she performs an unwanted action. The patient is awake, and feeling pain is the point of the shock.

The GED, when activated, outputs an electric shock that is distributed to the patient’s skin for up to two seconds. Students wear a backpack containing the shocking device, with electrodes constantly affixed to their skin. Staff are able to shock students at any point during the day. Previous attendees at JRC have spoken of up to five electrodes being attached to their bodies. One, Jen Msumba, who blogs about her time at the facility, said electrodes were applied under their fingers or the bottom of their feet to increase the pain.

The GED is not what we might call ‘electroshock therapy’ (picture here in 1946). Rather, shocks are used to deter an unwanted action. Photograph: Kurt Hutton/Getty Images

“We’ve all experienced aversive conditioning. We touch the stove while it’s still hot, it hurts, then we become very cautious about touching it,” says Dr Jean Mercer, the leader of the group Advocates for Children in Therapy, a not-for-profit organization dedicated to ending harmful practices for treating children’s mental health.

Mercer says there are some times in which aversive conditioning can be useful, for example in stopping socially destructive behaviors such as public masturbation or defecation, or physically destructive behaviors such as cutting skin, scratching or gouging oneself.

But at JRC, students claim it is being used non-contingently for a wide range of unwanted behaviors. According to a case brought by McCollins, shocks were administered for crimes as minor as not taking your coat off, or for screaming during previous shocks. A 2006 report by the New York state education department found children were shocked for “nagging, swearing, and failing to maintain a neat appearance”.

Mercer says this kind of usage is not effective, and that it is more likely “the person becomes generally distressed and anxious without losing the unwanted behavior”. She adds that aversive conditioning is only effective when the process is not especially painful.

As parents, making the decision to use aversive treatments comes after all else has failed

JRC Parents Group

While non-lethal, the GED shocks can cause a patient to suffer a variety of side-effects, including skin burns, heart complications, post-traumatic stress and increased paranoia from fear of punishment.

The practice has drawn overwhelming backlash from clinical psychologists, state officials and civil liberty groups like the ACLU, which protest the cruelty and inhumane nature of shock therapy. In 2012, New York magazine ran an exposé featuring the case of McCollins, a former patient of JRC who spent six hours undergoing 31 shocks and was left in a catatonic state for a month afterwards. It was McCollins who appeared in the footage that was released to the public as part of a lawsuit filed against the center by Andre’s mother, Cheryl McCollins, who compared the GED to a form of torture.

In a statement by the JRC Parents Group, parents provided unwavering support of the court’s decision, citing that their choice to continue with the shock therapy was not only out of necessity, but also out of desperation: “As parents, making the decision to use aversive treatments comes after all else has failed our children,” read the statement. “No one loves our children more than we do […] but as the court found – there is no evidence that any alternative treatment would be effective to treat our children and keep them safe.”

With another legal hurdle cleared, the Judge Rotenberg Center will move forward, electric shocks and all. The fight against the GED, however, is far from over. In 2014, an online petition calling for a ban on “torturous shock devices used on special needs people” garnered almost 300,000 signatures. This prompted the FDA to release a formalized proposal to prohibit all “electrical stimulation devices” used in aversive conditioning, but it has been kept in limbo since 2016.

Some parents insist the treatment works. The JRC Parents Group told ABC News: “Some of these parents have been dealing with these issues for 15 years. There are times when children attack their own parents. To people who think we don’t care, it’s not that, but it is an option when everything else fails.”